Langley Park Learning Trust: Consent for COVID-19 testing in school

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• For pupils younger than 16 years - this form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to participate in testing

• Pupils aged 16 and over who are able to provide informed consent - can complete this form themselves, having discussed participation with their parent / guardian if under 18

• For any pupil or student who does not have the capacity to provide informed consent - this form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to participate in testing.

I am completing this form for: *

Myself, as I am a pupil aged 16 or over

My child who is aged under 16, or is 16 or over but does not have the capacity to provide informed consent

I have had the opportunity to consider the information provided by the school about the testing, ask questions and have had these answered satisfactorily, based on the information presented and the Privacy Notice. *

Yes

In the case of under 16s, I have discussed the testing with my child and my child is happy to participate. If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test. *

Yes

Not applicable

I consent to having / my child having a nose and throat swab for lateral flow tests. I / my child will self-swab if I / my child is able to otherwise I understand that assistance is available *

Yes

I understand that there may be multiple tests required and this consent covers all tests for the below named person. If, on the day of testing I / they do not wish to take part, then I understand I / they will not be made to do so and that consent can be withdrawn at any time ahead of the test. *

Yes

I consent that my / my child’s sample(s) will be tested for the presence of COVID-19. *

Yes

I understand that if my /my child’s result(s) are negative on the lateral flow test I will not be contacted by the school/college except where I am / they are a close contact of a confirmed positive. *

Yes

If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that I / my child is removed from school premises as promptly as possible, bearing in mind I / they may have some anxiety following a positive test result. *

Yes

I understand that I / they will need to self-isolate following a positive lateral flow test result. *

Yes

I agree that if my / my child’s test results are confirmed to be positive from this lateral flow test, I will report this to the school / college and I understand that I/ my child will be required to self-isolate following public health advice. *

Yes

I understand that if a close contact of myself / my child tests positive that I / my child will self-isolate for 10 days in line with Government guidance. *

Yes

First name of pupil *

Surname of pupil *

School *

Langley Boys'

Langley Girls'

Year group *

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

Full name of parent/carer (for under-16s only)

Relationship to the child (for under-16s only)

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